Euthanasia Slippery slope or act of kindness?

Edexcel special

Euthanasia Slippery slope or act of kindness?

Arguably, we will see active or voluntary euthanasia legalised within a generation. A perennial issue of enormous significance to moral philosophy and a popular topic in the Investigations exam paper, euthanasia deserves a deeper understanding than is sometimes the case

Edexcel special paper 6RS02 1C

What happens when medical treatment can do no more for a person? Do we carry on with treatment or should we help them to die? Euthanasia is a highly contentious moral issue that has long divided both religious and secular opinion. In an age when funds are restricted and the population growing, calls for the legalisation of euthanasia will increase.

Euthanasia is a medical procedure by which a person who is suffering from a very painful or terminal illness, or who may be seriously brain damaged and beyond assistance is helped to die, perhaps by a doctor. ‘Euthanasia’ comes from the Greek words eu meaning ‘well’ or ‘good’ and thanatos meaning ‘death’. It literally means ‘good death’. The New Dictionary of Christian Ethics defines it as:

‘the intentional killing by act or omission, of one whose life is deemed not worth living.’

The value of personhood

But what makes someone’s life ‘not worth living’? Here lies the controversy. For some, it means the killing of a person who is unable to express their own desire as to whether they want to live or die — for example, someone in a long-term coma or a persistent vegetative state (PVS). Here, the issue is: ‘At what point does someone cease to be a person?’

This is difficult because advances in medical science have changed our perception of personhood and death. We know now, for example, that just because a heart stops, it doesn’t mean a person is dead. Even ‘brain death’ is problematic — does it mean the death of the whole brain, the higher functions only or brainstem death?

One well-known example of this was the case of Tony Bland, who was severely injured in the Hillsborough football tragedy of 1989. He was diagnosed as being in a PVS. His family wanted his treatment to stop and for Tony to be allowed to die. This is known as non-voluntary or passive euthanasia. It took a 4-year battle in the courts before it was agreed that the artificial feeding could be stopped and Tony died in 1993. Critics expressed the view that, had euthanasia been legal in this situation, it would have been a kinder option for all concerned.

Active euthanasia

Active or voluntary euthanasia is where an action deliberately designed to end a life is at the specific request of the dying person. That person might ask a doctor or other person to carry out the action, and it is then usually referred to as assisted suicide (e.g. by lethal injection, or by taking them to a clinic abroad where they will be assisted to die). This is illegal in the UK and, under the Homicide Act 1957, it is a crime to deliberately or recklessly bring about the death of another person without just cause. Depending on the circumstances, this will be deemed to be murder or manslaughter and the offender is liable to be imprisoned.

In 1993, the House of Lords rejected a proposal to legalise euthanasia, saying: ‘It would be next to impossible to ensure that all acts of euthanasia were truly voluntary’. Interestingly, in Belgium and the Netherlands, active euthanasia is permitted for the terminally ill who have expressed a desire to die and where two doctors and a panel of experts have agreed. In the UK, meanwhile, a survey by Brunel University disclosed that in 2003 936 people died by voluntary euthanasia and 1,930 by involuntary euthanasia.

Changing the law

There have been demands for the law to be changed in the UK, particularly concerning assisted suicide. In a similar way, it has been argued that people ought to have the right to sign a legal document called a living will or advance directive which says that, if they ever suffer serious brain damage, they should be allowed to die and not to receive medical treatment. At present, such documents are not legally valid in the UK.

Many groups have campaigned to have the law changed to allow active or voluntary euthanasia. One group, Dignity in Dying, argues:

‘For everyone to be guaranteed choice and dignity at the end of their life…a legal right to effective pain relief and help to ease suffering… . We want a full range of choices to be available to terminally ill people including medically assisted dying within strict legal safeguards.’

www.dignityindying.org.uk

Diane Pretty and Daniel James

A good example of this is the case of Diane Pretty, who had incurable motor neurone disease. Her mind was sharp but her muscles were fading away, leaving her in a wheelchair. She went to court to argue that it was her human right to die and she wanted her husband to help her to commit suicide. The court said that this was illegal and she had no right to die. Ultimately she died without euthanasia in 2002.

In recent times, a number of British people have visited a controversial Swiss organisation called Dignitas, which runs a clinic that enables those with terminal illnesses to undergo assisted suicide. A person who wishes to die first meets with the doctors, who must consent to the assisted suicide procedure. Assisted suicides are carried out by lethal injection or drink and the person dies peacefully.

Consider the case of Daniel James, aged 23, who suffered a terrible accident while playing rugby and was left paralysed. He was in constant pain, could not move and needed 24-hour care. Daniel tried on three occasions to commit suicide, but was unable to do so. Finally, he asked his parents to take him to the Dignitas clinic in Switzerland. They reluctantly agreed and he died peacefully there by euthanasia. Many people criticised Daniel’s parents for letting him die when he was so young and mentally able. His mother said that it was a decision made out of love and compassion.

A time for change?

Is it time for euthanasia to be legalised in the UK? Supporters claim that people have personal autonomy and that everyone should be allowed to make important decisions concerning their own lives. Indeed, the General Medical Council’s ‘Good medical practice’ guide (2013) states that doctors should respond to patients’ concerns and respect their rights when making decisions about their medical treatment and care. Moreover, it could be argued, it would be a better use of limited NHS resources to spend money on treating younger patients who are more likely to recover.

Similarly, people are entitled to a reasonable quality of life, which includes physical, intellectual and emotional wellbeing. If, through severe illness, a person is in great pain or no longer has a real quality of life, then perhaps they should be allowed to have their life ended in a dignified manner, if that is what he or she wishes. For example, many people would prefer to die than suffer from dementia, and also relieve their families from the huge emotional and physical effect of the disease.

There is an anomaly — if passive euthanasia (withdrawing medical treatment) is legal, then why is active euthanasia, through say a lethal injection, illegal? Is there a difference? Moreover, since euthanasia is legal in other countries and many UK citizens are forced to go abroad to clinics such as Dignitas to die, wouldn’t it ease distress if people were allowed to die with dignity in their own homes?

However, there are strong arguments against the legalisation of euthanasia. Many religious believers argue that euthanasia is against God’s will because life is created by God for a purpose and should only be ended by God.

On the medical side, some argue that if doctors had the right to end life, then people would feel less confident about them being able to treat and save lives. Moreover, doctors may wrongly diagnose that someone is terminally ill — for example, people with severe brain injuries can recover. If we allow euthanasia, then other controversial issues might follow — infanticide, killing of the disabled etc. Also, euthanasia could become compulsory and may make us view life as less important.

Religious perspectives

Religious views are divided, with arguments on both sides.

Christians

Some Christians believe that euthanasia and assisted suicide are wrong because they go against the teachings of the Bible, most notably that all people are made by God and given life by him. This is called the sanctity of life. Pope John Paul II said: ‘Euthanasia is a grave violation of the law of God, since it is the deliberate and morally unacceptable killing of a human person’ (Evangelium Vitae 1995).

Muslims

Many Muslims believe that euthanasia is strictly forbidden because life is a gift from God and must be treated with respect and that only God can take away life. Muslims believe that suffering is a test from God and to encourage anyone to end their life is a grave sin: ‘Do not kill yourselves, for truly God has been most merciful to you’ (Surah 4:29).

Jews

Some Jews believe that euthanasia is wrong because only God, the creator, can take life away. Jews are required by the Ten Commandments to ‘Honour your father and mother’ (Exodus 20:12). Jews should not seek to end the lives of their parents and the Ten Commandments say ‘Do not murder’ (Exodus 20:13).

Hindus

Hindus believe in reincarnation and many oppose euthanasia because all life is sacred and it is wrong to end a person’s life early through euthanasia, as this will lead to bad karma and a poor rebirth. The principle of ahimsa (non-violence) means that people must be cared for: ‘The one who tries to escape from the trials of life by committing suicide will suffer even more in the next life’ (Yajur Veda 40–43).

Buddhists

Many Buddhists believe that euthanasia is wrong because the way life ends is important and has an effect on the cycle of rebirth. Euthanasia would affect this. The teachings of metta (love) and karuna (compassion) prevent the deliberate killing of a person: ‘You shall not kill a living being, nor cause it to be killed’ (Sutta Nipata 11:14).

Sikhs

Many Sikhs are opposed to euthanasia because life and death are for God to decide and suffering may be a test from God and part of his plan to give people the opportunity to develop good karma: ‘God sends us and we take birth. God calls us back and we die’ (Guru Granth Sahib 1239).

The other side

However, many Christians believe that allowing someone to die with dignity may be the most loving and compassionate thing to do and that euthanasia is not ‘murder’ because it is not done with the intention of causing harm, but to end suffering. Similarly,

Muslims and Jews may accept that euthanasia may be the most compassionate thing to do and is more natural than being kept alive by drugs. For Hindus and Buddhists, the ending of a person’s life of suffering can be a good deed and bring about spiritual benefit. For Sikhs, the quality of life is what matters, not the length, and ending life may be preferable to artificially prolonging it.

Solutions

So what is the answer? Many people today say that the best solution lies with the hospice movement. A hospice is a place where terminally ill patients are cared for using palliative treatment — care which takes away the extremes of suffering with pain control, and allows people to live out their days in peace and dignity. There are over 100 hospices in the UK today.

Recently, there have been some amendments to the law in the UK. The Mental Capacity Act 2007 provides that the patient may appoint a representative with power of attorney to instruct doctors to stop giving treatment. Moreover, the February 2010 government guidelines state that those who help loved ones to die (assisted suicide) may not be prosecuted if the victim is in their right mind and asks for help to die. The person helping must be a close relative or friend acting out of love and compassion and they must report to the police immediately.

Supporters say that this does not go far enough, while opponents say that euthanasia is creeping in through the back door. Whatever the rights and wrongs, the situation remains confused. Perhaps we are not yet ready to decide.

This ‘Edexcel special’ is the responsibility of RELIGIOUS STUDIES REVIEW and has been neither provided nor approved by Edexcel.